Surgery to go up for auction on Web site

Come February, hundreds--and possibly thousands--of surgeons will join
the Internet auction craze, bidding to win your business for a face-lift,
laser eye surgery, breast augmentation and many other procedures.

Medicineonline.com, a California-based company, is ready to launch a
section of its Web site that will offer surgery for auction.

The plan has medical ethicists and physicians split.

"This idea is totally irresponsible," says Dr. Mimis Cohen, a
board-certified plastic surgeon and professor and chief of plastic surgery
at the University of Illinois at Chicago and Cook County Hospital. "If you
cut prices to be competitive, you can expect people to start cutting
corners. This is not like an airline seat; these are human lives."

But the Rev. Russell Burck, director of the program in ethics at
Rush-Presbyterian-St. Luke's Medical Center, said the service is in line
with common ethical teaching that puts the patient in charge of
establishing and maintaining the doctor-patient relationship.

"It's a way of recognizing that the patient is in the driver's seat,"
Burck said.

"Just because they set up their business on an auction site online, it
doesn't mean doctors are freed from doing their best work," Burck said. "I
can't quite yet see why putting out your face-lift for bids is different
from putting out, say, adding a room to your house for bids."

The American Medical Association has no policy on the service, but a
representative called the idea "bizarre."

"It will be wonderful for the consumer," says Medicineonline.com CEO
Kevin Moshayedi.

A veritable eBay of scalpels and stitches, it will work like this:

People who want surgery will post their information on the company's
Web site. Participating physicians--thousands of them--will then have the
opportunity to bid for the privilege of performing that surgery. The
company, which intends to launch the service Feb. 1, plans at least for
now to offer these auctions only for elective, non-emergency surgeries
such as face-lifts, rhinoplasties, breast augmentations, bunion removal,
cosmetic dentistry and laser eye surgery.

In theory, patients using Medicineonline .com's bid-for-surgery site
would select the surgeon who submits the lowest bid. Butdespite
the auction format, Moshayedi says price might often play a secondary
role.

Moshayedi says bidding physicians are required by the site to provide
not just a price for the procedure, but other information including where
the doctor went to medical school, the doctor's experience in similar
procedures, where and by whom the doctor is licensed and certified, and
even whether the doctor has had to defend any malpractice lawsuits.

"People hear about this and maybe they think it's all about money,"
says Dr. Javad Afshar, Medicineonline.com's chief financial officer. "But
you'll see many patients select doctors with the higher price because that
doctor's credentials are better. So it's not all about money at all."

Dr. Joel Frader, a pediatrician and associate professor of medical
ethics and humanities at Northwestern University Medical School, scoffs.
"Not about money? Then why call it an auction?"

Frader says, "The essence of virtually all patient care, including
cosmetic surgery, is the development of the relationship of trust between
patient, physician and even the patient's family. This focus on price
might make those relationships suffer."

Medicineonline.com contends that its site will urge patients and
doctors to have a personal consultation before entering into any surgical
arrangements.

But Frader says, "The question remains how much a patient will be
influenced by the fact that the doctor he chose is 20 percent cheaper than
the next lowest bidder. It's very important, when evaluating a doctor, to
guard against thinking money is more important than trust or the
relationship.

"As for learning about credentials or board
certifications or where a doctor went to medical school, it's still more
important to find the right relationship. If you check out all the
credentials online, then end up hating the surgeon, it probably wasn't a
good idea to have that surgeon operate on you."

Elizabeth Williams, a 31-year-old Chicago attorney, is in the market
for LASIK, a pricey laser eye surgery that has become one of America's
fastest-growing elective surgical procedures.

Williams says Medicineonline.com would be hard-pressed to persuade her
to use a doctor she found on their site. But it might not be impossible.

"I'm very partial to getting personal referrals,
especially if someone's going to be messing with my eyes," Williams says.
"Price is important, but not so important that I'd pass on a referral from
someone I trusted."

LASIK can cost more than $5,000. What if a surgeon she discovered
online could save her, say, $2,000 on the procedure?

"I would consider it," Williams says. "But they'd still be very
hard-pressed to convince me to go to someone who wasn't personally
recommended to me. What I might do, if a doctor's information looked good
online, and he was significantly less expensive, is investigate further,
look for referrals, see if I felt comfortable with that doctor's previous
patients.

"But," Williams says, "it would have to save me a significant chunk of
money to even get started."

So far, only 300 physicians--mostly California-based, and none in
Illinois--have enlisted with Medicineonline.com. Physicians will be
allowed to join Medicineonline .com for free. Patients also will pay
nothing, at least for the first few months. Thereafter, the company might
charge a nominal fee--say, $1--to discourage recreational use.

Medicineonline.com intends to generate revenue by selling advertising,
prescriptions, medical and office supplies, and physician services through
its site.

What the site will not do is auction more serious procedures such as
heart bypasses and lung transplants, at least for now.

"The infrastructure and technology to do more serious procedures is
there, and can be expanded," Moshayedi says. "But we don't have a plan to
go that route. I'd say it's a very slim possibility for the future,
because emergency procedures are usually covered by insurance, so price is
less an issue."

Dr. Richard Van Meter, a California internist and Medicineonline.com
executive board member, says that when he first heard of the idea "I was
absolutely skeptical. I thought, this is lowering our standards. But when
a physician understands the basic premise, which is giving the patient
needed information, they usually come around."

Dr. Mimis Cohen remains wary. Emphasize price, as any auction site
necessarily must, and quality will suffer. Cohen thinks that the emphasis
on price might encourage new, young physicians struggling in HMOs to slash
prices in order to generate clientele and cash flow. He warns about
serious complications that can arise during even routine, elective
procedures. And he's especially concerned about all this credential
business.

"A doctor can put on paper anything he wants," Cohen says. "It's easy
to make yourself look much more credentialed and experienced than you
really are. Is that Web site going to guarantee that their doctors'
credentials are meaningful--or even legitimate?"

Van Meter says that Medicineonline.com will guarantee no such thing.
"If a doctor wants to lie on his resume, that's not Medicineonline's
problem, it's the consumer's problem. That keeps liability out of MOL's
lap. Remember, MOL is an informational source."